Adjuvant Radiation Therapy Following Radical Prostatectomy for Pathologic T3 or Margin-positive Prostate Cancer: Are the EAU Guidelines Correct?

ObjectiveTo present a critical review of the published data as to whether adjuvant radiation therapy (RT) is the preferred first line of management for pathologic T3 or margin-positive prostate cancer (PCa) after radical prostatectomy (RP), which has level 1B evidence in the European Association of Urology (EAU) guidelines.MethodsThree randomised studies have been published comparing immediate adjuvant RT and salvage treatment in patients with pT3 and/or margin-positive PCa. The concept of these trials was critically evaluated, and the translation of the outcome of these trials to daily clinical practice is discussed.ResultsCurrent evidence is insufficient to subject all patients with pT3 and/or margin-positive PCa to adjuvant RT after RP, and it should be reserved for a subset of patients with adverse prognostic factors after RP, such as seminal vesicle invasion.ConclusionsThe data that can be retrieved from the trials exploring the benefit of adjuvant RT following RP cannot be translated to routine clinical urologic practice, because the field of PCa is changing rapidly and the patients present at an earlier stage. A trial evaluating immediate versus salvage RT should answer the question of who needs adjuvant treatment and when. The recommendation concerning adjuvant RT should thus be adapted in the EAU guidelines.